A 39-year-old man presented at our Endoscopy Unit with an age of 39 years to filiate the nature of a submucosal lesion located in the gastric side of the gastroesophageal junction.
The patient begins his medical study in the Department of Otolaryngology where he consults for pharyngeal discomfort.
After the explorations carried out by this service, it was decided to perform an upper digestive endoscopy, where it was evident, 36 cm of dental arch, a rounded lesion with a larger endoscopic mucosa of approximately 1.5 cm.
The presence of a submucosal lesion whose nature is not possible to filiate through endoscopic imaging or after the histological study of biopsies is sent to our center for an endoscopic ultrasound (EUS).
EUS is performed on an outpatient basis, under monitoring vital signs and conscious sedation based on midazolam and pethidine.
An echoendo lineal Pentax EG3830UX coupled to an ultrasound machine Hitachi 8500 was used.
36 cm of dental arch identifies a small, well-defined, cystic anechoic lesion that seems to depend on the submucosa of 14 x 6 mm of maximum diameter.
The ultrasonographic study did not identify the presence of abdominal or mediastinal lymph nodes and the integrity of the vascular axis was demonstrated.
Once the lesion to be punctured was identified, an ultrasound study with color doppler was performed to avoid vascular formations and to identify the most appropriate path to perform the puncture.
The Echotip Wilson needle is used for this puncture. First, the needle sheath is removed a few centimeters through the working channel until it is visualized either gastroscopically or ultrasoundally.
Once verified its position inside the lesion, the stylet is removed (which is used to prevent possible contamination of the sample) and maneuvers are performed to advance the needle in order to extract the material as much as possible.
In our case, we used an aspiration syringe to increase the cellularity of the sample.
Two steps are taken on the lesion until the pathologist, present in the examination room, confirms the sufficiency of the sample.
1.
Diff-Quick (Merck) staining was used to evaluate the sample in the examination room and the cytological study was completed with Papanicolau staining (Merck).
Cytological examination showed abundant foamy histiocytes with scarce cydrical epithelium consistent with cyst gastric duplication cyst.
